Knowledge, attitudes, and practices regarding coccidioidomycosis among healthcare providers in four counties in Washington State, 2017.

Coccidioidomycosis is an emerging infection in Washington State. The epidemiology of the disease in Washington is poorly understood at present; underrecognition and underreporting of coccidioidomycosis is suspected based on reports of only severe disease. We sought to characterize healthcare provider knowledge, attitudes, and practices regarding coccidioidomycosis awareness, diagnosis, and treatment in south-central Washington. We conducted a cross-sectional survey of actively practicing healthcare providers in four counties in south-central Washington, an area recently described as endemic for Coccidioides. Survey results were used to assess awareness of reporting requirements, confidence in ability to diagnose and treat, confidence that knowledge is current, calculated knowledge score, and consideration of risk in patient population. The majority of respondents were unaware of the reporting requirement for coccidioidomycosis in Washington and further unaware that the disease had been reported in the state. Less than a third of survey respondents reported confidence in their ability to diagnose coccidioidomycosis and confidence that their knowledge is current. The majority of respondents never or rarely consider a diagnosis of coccidioidomycosis, and <25% of respondents indicated a working knowledge of serologic tests for the infection. The average knowledge score for respondents was 65%. Previous education, training, or practice regarding coccidioidomycosis was the only identified predictor of confidence and consideration of risk. These data indicate the substantial need for education and training among healthcare providers in south-central Washington and support the concern that a small proportion of existing cases of coccidioidomycosis are reported to the health department.

Reading grade levels and health behaviors of parents at child clinics.

OBJECTIVES: Recent reports suggest alarmingly low levels of literacy among adults in the U.S., but these are not expressed in grade levels. Assessment of the epidemiology of reading grade levels is necessary for development of patient education materials written at appropriate levels. METHODS: We measured demographics, reading ability and self-described health behaviors of 646 parents at two private, two university, two indigent and six public child-related clinics in a midwestern city using a bilingual oral interview and the Wide Range Achievement Test. RESULTS: Parents were 59% white, 92% female, with mean age 28 years, mean years of school 12.1 and mean reading grade 8.7. Parents tended to read four to five grades below their highest completed school grade. Analysis of self-reported health behaviors showed that 69% had no private insurance, 31% smoked cigarettes, 35% had body mass index greater than 27, and 46% of parous mothers had never breast-fed. Prevalence odds ratios showed that all adverse health risks except obesity were associated with low reading ability. CONCLUSIONS: These findings have important implications for public health professionals working in clinical care, health education and agency policy. Persons with low literacy levels appear to be at particularly high risk for adverse health behaviors. Education materials and teaching vocabulary should be appropriate for client reading grade levels.

A cooperative effort to pass tobacco control ordinances in Wichita, Kansas.

In October 1993, the Tobacco-Free Wichita Coalition proposed ordinances to the Wichita City Council that would tightly control access of minors to tobacco and prohibit smoking in public places. The subsequent successful change in local health policy required the collaborative efforts of local and state organizations and health agencies. A simple random telephone survey commissioned and financed by the coalition demonstrated that 76 percent (95 percent CI = 72 percent to 80 percent) of adult Wichita-Sedgwick County residents favored enforced penalties for merchants selling tobacco to minors, and 62 percent (95 percent CI = 58 percent to 66 percent) favored a ban on tobacco vending machines. Fifty-four percent (95 percent CI = 50 percent to 58 percent) favored a smoking ban in all public places.

Surveillance for dust storms and respiratory diseases in Washington State, 1991.

Southeast Washington State, which has a long history of seasonal dust storms, experienced 2 d of dust storms in October 1991, during which PM10 levels exceeded 1,000 micrograms/m3 (i.e., six times greater than the Environmental Protection Agency's 24-h PM10 standard). Three community hospitals in southeast Washington were visited for the purpose of assessing the possible effects of dust storms on respiratory health. During these visits, the number of emergency room visits for respiratory disorders for each day of 1991 were abstracted. These numbers were compared with daily PM10 levels for 1991. Also determined were the observed/expected ratios for the number of emergency room visits for each respiratory disorder category during October 1991. The maximum observed/expected ratio for the respiratory disorders was 1.2. For 1991, we found a 3.5% increase in the number of daily emergency room visits for bronchitis for each 100 micrograms/m3 increase in PM10. In addition, 2 d subsequent to those days on which the PM10 levels exceeded 150 micrograms/m3, there was a 4.5% increase in the number of emergency room visits for sinusitis for each 100 micrograms/m3 increase in PM10. Our results indicate that the naturally occurring PM10 in this setting has a small effect on the respiratory health of the population in general.